To the Editor Certain points regarding precision medicine made in the Viewpoint by Drs Khoury and Galea1 warrant further discussion. We agree with the authors that genomics in isolation lacks requisite granularity and phenotype is not determined solely by genetic makeup. Gene expression is influenced by various factors, including complex environmental cues such as exercise and diet. To fully leverage the utility of precision medicine, other biological compartments will need to be assessed, such as the proteome, the metabolome, and, of significant interest to population health, the human microbiome.2,3 High fidelity and affordable technologies are making this possible, and a combinatorial “multiomics” approach may shed more light on disease-risk profiles than genomics has been able to in isolation.
Hoosien M, Elshazly MB. Evaluating Precision Medicine’s Ability to Improve Population Health. JAMA. 2017;317(4):440-441. doi:10.1001/jama.2016.20000